Author: Marc

I have been thinking a lot about craving lately. What is craving, really? What’s it all about?

Craving seems to amount to a fundamental sense of being incomplete. When we crave, we want something to fill us up. We want to fill a hole, by taking something out there in the world and putting it into ourselves.

We’ve talked about ego fatigue and delay discounting lately. These are phenomena that strengthen the impulsive urge to take something – now! But where does that urge come from? What’s its origin, and what form does it take in our inner worlds?

I’ve long thought that most people who become addicted to something have been badly hurt or scarred while growing up. This view is shared by many others, including Gabor Maté, our Canadian addiction specialist. So we’ve been shamed or rejected by parents or close friends, punished when we didn’t expect it or understand it, bullied, raped, or abandoned, or maybe we’ve lost someone dear to us, maybe more than once.

Yet these wounds don’t explain the craving for something else. They explain why we suffer.

The thing is that suffering is part of life. Many many people in the world accept suffering as inevitable. Many who suffer do not become addicts. But for those of us who have been addicted, there seems to be a fundamental expectation that’s truly flawed: the expectation that we can be made complete by something out there in the world. What made us think that? What made us imagine that we could relieve our suffering in that way? Or does addiction reflect some crazy optimism, a hope for relief that never gets extinguished?

Addiction must start off with the very real experience of getting relief from something outside ourselves: a substance (like booze or drugs) or an act (like gambling or sex). We naturally stumble on such experiences in adolescence or young adulthood. (And note that addictive “acts” also put something into the self: a feeling of triumph or pleasure that was not otherwise available.) Then the thing that provides relief becomes a goal with greater and greater draw. Hence, we crave it when we have to go without.

Yet the conclusion that we become more complete when we have that thing…that can’t just come from a few arbitrary experiences of intoxication or pleasure. We must come prepared — predisposed — to feel that way. And then we find the key that fits the hole.

The belief that we are incomplete without that thing seems like a fundamental, bedrock assumption at the root of craving and pursuing addictive activities. What could be its origin?

More soon…but I’d like to hear your thoughts first.

Okay, where were we? Ego fatigue. The empty-tank syndrome, losing your resolve when you’ve been trying too hard or for too long or both. The comment thread has been really valuable: Many of you know exactly what this feels like. And we seem to recognize that this phenomenon is critical when it comes to relapse.

The classic ego fatigue test was developed by a psychologist named Baumeister and published in a 1998 article in a standard psychology journal. He put hungry people into a room and left them alone with two bowls in front of them: a bowl of radishes and a bowl of chocolate-chip cookies. Half were instructed to have some cookies but no radishes; the other half were instructed to eat radishes only – no cookies. After only five minutes, the participants were asked to perform some cognitive tasks that require self-control. Those who’d had to resist temptation (cookies) performed more poorly or quit earlier. The interpretation was that they had “depleted” a resource needed for self-control.

In the same paper, another experiment was reported, one that’s at least as relevant. Participants watched a 10-minute video clip that was very emotionally arousing (either humorous or tragic). Half were asked to show no emotion on their faces, and the other half could behave normally. Those who had to suppress their emotions performed more poorly on subsequent tasks. Once again, something had been depleted.

These studies have the “toy” quality of many psychology experiments. But they seemed to tap something important. In the past 12 years, ego fatigue (or ego depletion) has been studied in many other labs, sometimes with very clever procedures and strong results. In the field of addiction research, there has been increasing recognition that ego fatigue is a serious problem for recovering addicts. But I’d say that those of us who have been addicts are the real experts.

If 5 minutes of resisting temptation actually lowers your cognitive control, what’s the impact of 5 hours? If 10 minutes of suppressing your feelings saps your cognitive reserves, imagine the impact of suppressing those feelings (deliberately and consciously) all day long, day after day. You know what I mean, and reader comments on the last two posts fill out many of the details. Rather than repeat them here, let’s move on.

Ego fatigue is not simple and it does not act in isolation. Many of us have expressed immense relief, triumph, or joy when we finally give way to temptation. At least for a while. Next post, I’ll write more about the “multiple personality” issue that I think is involved. For now, I want to mention one other psychological phenomenon that is joined at the hip with ego fatigue.

Delay discounting is the common finding that people (and animals!) will prefer an immediate reward of lower value to a later reward of higher value, even though there’s less overall gain. People who are naturally impulsive are the most prone. Delay discounting has a lot to do with dopamine’s short-sightedness. Dopamine enhances the draw of immediate goals, and that’s all it cares about. Your higher brain processes are supposed to look out for the future. So the dopamine rush of craving and the urgent pull of present opportunities are intimately linked in your brain. And the higher brain processes…well that’s the problem.

The following video, of kids in the “marshmallow test,” shows how agonizing it can be to fight present temptations.

The Marshmallow Test

This video also shows how we try to fight against delay discounting, especially when we know how DUMB it is to give in to immediate temptation (and when there’s a moral imperative to hold out). But what I really wanted you to see is the gyrations these kids go through, trying to resist. The whole task brings on massive ego fatigue for any 3-4-year old. It’s hard to keep resisting what’s right in front of you! And the ones who make it all the way sometimes seem to suffer most.

What’s different about the successful ones, if anything? They sniff it, fondle it, smell it, even kiss it, and then they look away. They scrunch up their little noses and they look away, or look down, or pretend it’s not there. That’s the point: they distance themselves from it, before ego fatigue overcomes them.

We addicts often “discount” the value of sobriety, because the payoff is in the future. Instead we break down and choose the immediate reward. We lunge for the marshmallow — sometimes after ego fatigue has already sapped our strength, and sometimes when we just want to skip the whole, familiar, gruelling process of self-denial.

But there is a way out. We can learn something from these 3-year-olds. Look away, look away. In fact, because we’re adults, we can go one better. Don’t just look away but get yourself out of the room, or out of the neighbourhood, or get the wine out of the house, before the “humming” takes over.

The 11th Commandment: Avoid temptation.

There were a lot of comments on my last post. Any of us who have been there know about the pivot point, and some readers felt that this was a critical moment, a key to the whole cycle of addiction and readdiction. I gave it a name, ego fatigue, from the psychological literature. And I promised another few posts to explore this topic more deeply. So while I’m working on those posts, trying to incorporate all the articles Alese keeps sending me, I thought I’d fill the gap with a couple of pages from my book.

This excerpt is from the chapter in which I deal with ego fatigue, called Night Life in Rat Park. But the part I’m including below doesn’t get into the neuroscience — not yet. It’s just a read-out of the fantasies, the self-talk, the loosening sense of self-control that all start to slip and slide as you approach the pivot point. Or maybe it’s more like an accelerating ride over the crest of the toboggan run. Either way, from then on you’re lost. And the lesson, as several readers (and I) commented, is to not let yourself get into that state of “simmering” — the protracted, agonizing wrestling with the temptation to do it, pitched against the need to stop yourself.

This excerpt is from my life as a late-blooming undergraduate, working late at night in the rat lab:

I went in. I hung up my coat. I unlocked the door to the inner sanctum and made my way to the cages. My rats were all there, busy doing nothing, as usual. Scratching and whispering, scurrying, hiding, perhaps talking to each other in little rat voices. They paid me little attention. I was a familiar sight, or more likely a familiar odour, and we’d have time enough to visit as the night wore on. “Hi, little guys. Who wants to go first tonight?”

I pulled a cage out from the middle of the grid, just to make life interesting, and carried it to the procedure room, whispering all the way in my rat voice… I filled the pellet tray. I filled the water bottle. I made sure everything was perfect. On a fresh data sheet I recorded the date, February 12, 1977, the subject number, and his weight—before supper. Then I picked up the rat and placed him in the left wing of the experimental chamber… Finally, I lifted the slide between the two sections of the box and watched, horrified and amazed, that this little rat obeyed so perfectly the commands issued by his brain and his stomach. He did what he was programmed to do. Flawlessly.

I went through a dozen more animals, and I was still only half done. I wouldn’t arrive home until nearly midnight. Another long, lonely, boring night. And it was particularly lonely because Sharon and I had been fighting again. Always fighting… When things got difficult, as they had again now, I pleaded for her understanding, for her strength, or if those weren’t forthcoming, I pleaded for her to lay off. I didn’t want to feel that I was recalcitrant, naughty, unkind, unfair. I wanted her to put her arms around me when I got back, even if I got back at 2 a.m. No more fighting.

But now, as I shuttled about the lab, the angry, wounded wrinkle of her brow floated above me, behind me, and the resonance of her nasal voice rose from the hum of the fridge. The old lab fridge. Sitting in the corner of the procedure room. Would I? Should I? No! Once was enough. Somebody would find out. No they wouldn’t… Nobody is saving it up for the rats, that’s for sure. It’s going bad. It’s probably five years old. Yeah, but it works. It still works. Oh, does it ever. Yeah, and it’s probably toxic. You’re probably going to die. If you do what you’re thinking of doing. Don’t even think about it.

But I am thinking about it. I can’t stop thinking about it. And there were no ill effects last time . . . The bell went off and brought me back to reality. If this was reality. My first reaction was a rush of shame: it was vile. Shooting some undefined liquid into my veins. Okay, it was morphine. Morphine, the wonder drug. Morphine, the perfect narcotic. The pure essence of which everything else—even heroin—is a derivative. But it was disgusting to shoot that stale stuff in the fridge. A familiar glare from somewhere inside.

I picked up my now well-fed and well-exercised little beast, and it seemed as though he was smiling at me: I know what you’re thinking. No you don’t! I weighed him again, a bit more roughly this time, then put him back in his cage. You don’t know what I’m thinking, you dumb rat. It’s not your morphine anyway. To get my mind off the fridge, off Sharon, I put the next rat into the box and picked up my novel, plunked myself down on the musty sofa and started to read. Nobody was around. Not only the lab but the whole subbasement was deserted. No sound. Except for the scurrying of those rats still awaiting their moment of glory. And the others, the sated ones, licking their fur contentedly. A sound that grew louder in my imagination: soft tongues scratching and scraping as they cleaned their soft white fur. They were at peace. Like I would be if I . . . No no. Don’t go there. Not again.

I’m a big boy. I’m studying to be a psychologist. But I still like to read horror novels sometimes. Especially lately. And Anne Rice evokes the most compelling images. A newcomer has entered the parlour. One of the older vampires crosses the room so swiftly his movements are invisible. He grasps the visitor fondly by the lapels. He whispers to him, part seduction, part warning: “So you want to become one of us? But are you strong enough to bear the curse of isolation that will be yours forever? With a taste of my blood?” And I’m thinking about the morphine in the fridge again, because it is like the vampire’s blood: dirty, poisonous, yet offering me its singular powers. It will plunge me into the land that is inhabited by the few, the outcasts, those who prowl by night and sleep by day, whose business is the sating of a shameful hunger. And now other images are awakened. My memories of [old Berkeley friends, part-time junkies], both fond and repugnant. Ralph putting Jim to sleep with a shot of Seconal, a drug that would one day kill him. And my childish wish to be one of them, despite the foreshadowing of destruction that hovered there.

Only fifteen or so rats to go. I’ll never make it. Too long. Too tempting. Don’t think about it. Don’t think about the little bottles in the fridge. You might never have noticed them if you hadn’t been searching for a can of pop. And don’t think about the syringes lying so neatly in their paper wrappers in the cupboard. Don’t think about them! But I look at the vein in my arm, so rapidly I can’t stop myself. Up until a week ago, I hadn’t shot drugs for over two years. That’s all over. A youthful folly. With its share of horrors, to be sure. Nobody knows the trouble I’ve seen. Nobody knows . . . but Jesus. I’m actually humming this as I get up to replace one rat with the next. I’m humming this and I’m smiling a little to myself, smiling with a sneaky little smile, a sneaky little rat smile. A smile for no one. A smile no one can see. But there is a quickening in my pulse. A part of me has given up.

 

There is something terribly interesting about the moment of giving in. That moment when the teeter-totter crosses that invisible threshold, when the momentum shifts, when you know you’re going to do it, despite the hours of telling yourself you won’t. It’s a very distinct feeling, says a recent reader. It’s a lot different from thinking about getting high. It’s not thinking at all, really. It’s not imagining what it will be like. Rather, it’s a feeling of free fall, a release from the incessant gravity of your own rule book. It’s a massive change: from control to freedom, from responsibility to neglect, from wisdom to foolishness, from security to doom — all at the same time.

We’ve just come through the holiday season, most of us intact, I hope. And yet many of us may have slipped in one way or another. If you’re a recovering alcoholic, you may have buckled and started drinking. Maybe for a night, maybe for a week, or maybe you’re still drinking. If you’re a chipper (a sometimes addict), maybe you chipped at something a lot bigger and a lot more dangerous than you thought you would. If you live on the clean side of the line of self-indulgence for most of the days of your life, maybe you crossed the line — for an hour, a night, or a week — with a bottle, with your neighbour’s spouse, with a reckless ride through the dark side of the internet… What I’m interested in is that moment when you actually cross the line. When it’s no longer a choice that you continue to make or that you’re always about to make, but a choice (if you still want to call it that) you’ve already made. That’s when the free-fall starts…that pitch away from your centre of gravity to a new orbit, a new star, much brighter in that moment than the dull planet you’ve been calling home.

Sometimes the moment of giving in is barely conscious, and sometimes it comes long before there’s a full recognition that you’ve already changed orbits, irrevocably, and the crash landing is coming next. Just the other night I read of the “fall” of a reader/fellow blogger whom I respect very much. She’s a recovering alcoholic who gave in to a couple of drinks, and she wrote about it before, during, and after crossing the line. In one post she describes the moment when (I’d say) her intention shifted trajectories, though that moment was still embedded in the chatter of a familiar self-dialogue:

Today I was at the market and managed to talk myself into buying wine — for taking to a friend’s house for dinner tonight, of course, but the truth is  we don’t have to take wine. We’re bringing other things, so wine is probably a bit too much. But I talked myself into buying it anyway, “just in case”. Just in case WHAT, I now ask myself. I tell myself, you know. Who are you trying to kid, you know exactly just in case WHAT. What was I thinking? Ohhhh, I’m so far out on the limb I’m not sure I can get back.

At a certain point she warned herself, “One sip is too many…the dangers are huge…but the desire is chipping away at my resolve.”

Once you’ve said that to yourself, it’s pretty much game over.

In my years of addiction, I told myself many many times that my resolve was weakening. Like that terrible weekend in Thunder Bay when it became inevitable that I would steal more drugs. I had lost the belief that I was capable of self-control. And I was so fed up with the whole process that I took absurd chances that night and managed, finally, to get caught in the act and carted off to jail. To say “my resolve is weakening” is code for “I can’t stop myself anymore.”

But luckily, this blogger — someone I now consider a friend even though we’ve never met — stopped herself, just an hour or two later. Check out her second post. It’s a happy ending. Relapse is part of recovery, so they say.

Where am I going with this? I want to spend the next couple of posts thinking about loss of control – a major theme in the psychology and neuroscience of addiction. Psychologists have been studying a phenomenon known as “ego fatigue” for roughly ten years. That’s when you’ve been trying to suppress or inhibit an impulse continuously, for an hour or more, and the result is a breakdown in the self-regulatory function – which we think is housed in the anterior cingulate cortex (ACC: see my book for details). After excessive use (think of a car that’s been going uphill in first gear for an hour), that part of the brain literally runs out of its fuel supply (glutamate and/or GABA), and like an over-used muscle it just caves in. Recovering addicts have the unfortunate mission of maintaining active, effortful – sometimes tremendously effortful — self-control. Not just for an hour but for a day, several days, a week, maybe a month or more. Our neural machinery wasn’t made to take that kind of strain.

But that first pivotal moment of giving in doesn’t just feel like a branch breaking under too much weight. There is also excitement, tingling anticipation, hope, freedom, relief — and something a lot like pride — for some of us — a sense of triumph, just for that brief window of time. Now you are no longer ensnared in a tug-of-war between two ideal selves. Now you are wholly and completely you. Or so it seems.

In my next post I’ll get into some details, looking at people’s experience of the loss of control and the brain processes behind those experiences. Stay tuned.

Hello readers! Happy New Year and all that. I took a couple of weeks off for the holidays and went to visit family and friends back in Toronto. It was a time of heart-warming reconnection with people I’ve known for much of my life. But it was also a time of emotional pain: loss, disappointment, regret — stuff like that. Hence the topic of this post…

In a very cool blog called Neuroskeptic. I recently found a reference to a paper by Feinstein et al (2010, senior author Tramel), reporting on a man who had lost almost his entire limbic system.

The limbic system is a widely distributed assembly of very different structures, most notably the amygdala (responsible for emotional associations) and the hippocampus (necessary for encoding episodic memory so that events stay in mind for more than a few seconds). Some people include the ventral striatum (the foundation of anticipation and desire) and its source of dopamine, the VTA, all under the rubric of the limbic system. All these structures are “sub-cortical” — they are more primitive than the cortex. They are its underlying machinery, the stuff in the basement (though they are more advanced than other systems — the ancient engines still at work in the subbasement of the brain stem). And then there are higher structures, sometimes called limbic cortex — parts of the cortex bordering the limbic system. These include the orbitofrontal cortex, which appraises the value, likability or aversiveness of incoming stimuli, and the famous ACC (anterior cingulate cortex) which does response-monitoring, selective attention, and effortful engagement. (All these parts and their functions are described in detail in my book.)

Limbic structures are the basis of learning. They grow synapses that connect with all parts of the cortex. That’s how the sophisticated perceptions of the cortex remain anchored to an emotional self — a core self. The cortex houses the most advanced software, but its programs are grounded in meaning through the limbic system.

A man named Roger had just about all of his limbic system destroyed by a very nasty (and rare) herpes infection. Yes, herpes can be a lot worse than you think. To quote from Neuroskeptic: “…his is the worst case of herpes encephalitis damage among patients currently alive.” And he has been alive since the damage occurred 28 years ago. So what was the result? What happens when you lose your limbic system?

Roger lost his capacity to remember things from then on — called anterograde amnesia — but his mood improved! You’d think losing half your brain would make you a tad grumpy. But in the words of Feinstein et al: “He readily displays signs of positive emotion including happiness, amusement, interest, and excitement…”

The limbic system evolved with the advent of mammals. The limbic system allows us to play, to be social, to form attachments, to love, to feel our connection with others and with our own goals. And it allows us to suffer. Thanks to the limbic system, we struggle to be the best we can be so that we can partner with other mammals (mates, children, parents). And we expect the same from others. Unlike frogs, whose goals are hard-wired, mammals must learn to achieve what they want, and avoid what they fear, through emotional striving.

So the lesson I take from Roger is that the psychological qualities of creatures like ourselves come with a huge price tag: emotional pain. Roger lost the neural foundation of meaning — of what it feels like to be a human mammal — but he no longer experienced suffering. He became a happy camper in a shallow world.

To my mind, and to other students of addiction, like Gabor Mate, we drink or take drugs to reduce the fundamental pain of life — the emotional suffering that constitutes the background music of the mammalian nervous system. Like other evolutionary achievements, the limbic brain is a double-edged sword. And we use drugs and alcohol in order to protect ourselves from its savage blade. That’s why addiction is an inevitable byproduct of human evolution.